Provider First Line Business Practice Location Address:
427 S BERNARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-0107
Provider Business Practice Location Address Fax Number:
509-747-2635
Provider Enumeration Date:
07/12/2005